Journal of Primary Care and Community Health最新文献

{"title":"Obesity Stigma Among Healthcare Workers in a Teaching Hospital in Saudi Arabia.","authors":"Ahmed S Bahamdan, Marwa M Shafey, Assim M Alabdulkader, Adam F Aldhawyan, Khalid S Alharkan, Omar K Almohaimeed, Mohammad J Holdar","doi":"10.1177/21501319241303326","DOIUrl":"10.1177/21501319241303326","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a significant public health issue in Saudi Arabia. Rising obesity rates increase the risk of weight bias and stigma, even among healthcare workers.</p><p><strong>Objectives: </strong>This study assesses weight stigma in healthcare workers, with findings intended to inform strategies for creating a more supportive healthcare environment for patients with obesity.</p><p><strong>Methods: </strong>This cross-sectional study was conducted in a university hospital in the Eastern Province of Saudi Arabia. Healthcare workers completed self-administered questionnaires, including the Attitudes toward Obese Persons Scale (ATOP) and the Beliefs about Obese Persons Scale (BAOP), which assess levels of positive attitudes and beliefs about obesity, respectively. Data were analyzed using SPSS.</p><p><strong>Results: </strong>The study included 266 healthcare workers (HCWs), mean age 33.21 years, with 54.5% female. The ATOP mean score was 64.4, and BAOP mean score was 18.3, indicating moderate negative attitudes and beliefs toward obesity. Significant differences in ATOP scores were found based on age, patient interactions, and years of experience.</p><p><strong>Discussion: </strong>Our study aligns with international findings, revealing significant weight stigma among healthcare workers in Saudi Arabia. Such stigma can negatively impact patient care, leading to biased treatment and poorer health outcomes. Societal norms and personal biases contribute to this stigma, despite misconceptions regarding its supposed motivational effects. Addressing this requires comprehensive training and education for healthcare providers. Policymakers should include weight bias education into medical curricula and establish anti-discrimination policies to promote inclusivity and respect.</p><p><strong>Conclusions: </strong>Our study highlights obesity stigma among Saudi healthcare workers and the need for targeted interventions. Creating a supportive, nonjudgmental environment can enhance patient-provider relationships and improve healthcare outcomes for individuals with obesity.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241303326"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipid Management in Primary Care for Socioeconomically Disadvantaged Populations in Northern England: A Qualitative Study.","authors":"Yu Fu, Sarah Sewdon, Julia L Newton","doi":"10.1177/21501319241272026","DOIUrl":"10.1177/21501319241272026","url":null,"abstract":"<p><strong>Introduction: </strong>People in low socioeconomic circumstances are more susceptible to dyslipidemia and cardiovascular disease than those living in more affluent populations. Limited healthcare access and low preventive care uptake widen health inequalities. Understanding how primary care can better serve socioeconomically disadvantaged communities is urgently needed.</p><p><strong>Aim: </strong>To explore lipid management delivery in socioeconomically disadvantaged areas and identify barriers and enablers for lipid optimization for socioeconomically disadvantaged populations.</p><p><strong>Method: </strong>Individual semi-structured remote interviews with clinicians, purposively recruited from primary care practices serving extremely socioeconomically disadvantaged communities in Northern England, UK, who were involved in the delivery and organization of lipid management. Interviews were recorded, transcribed, and analyzed thematically following framework analysis.</p><p><strong>Results: </strong>Fifteen interviews were undertaken. Five themes emerged: complex and multimorbid patients with competing priorities, limited access and follow-up to supporting services, being flexible and working beyond guidelines, high workload with inadequate staff support, and the need for care integrity and sustainable support.</p><p><strong>Conclusion: </strong>The findings of this study have been fed back to the delivery of the national program to improve cardiovascular health. Socioeconomically disadvantaged communities have complex health needs posing risks of multimorbidity but living with low health literacy, competing demands upon time, and financial constraints. Clinicians are willing to adapt services but a lack of guidance for care and funded services remains a significant barrier to targeted service delivery. Research is needed to inform the effectiveness and acceptability of interventions for lipid management tailored for those experiencing low socioeconomic disadvantage.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241272026"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Psychiatry Clerkship at Nassau University Medical Center: A Mentorship Model in the Post-COVID-19 Era.","authors":"Guitelle St Victor, Albulena Ajeti, Saeed Ahmed, Lakshit Jain, Zouina Sarfraz, Ulziibat Person","doi":"10.1177/21501319241304142","DOIUrl":"10.1177/21501319241304142","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the impact of the mentorship model used in the psychiatry clerkship at Nassau University Medical Center (NUMC), with a focus on its effectiveness in improving medical knowledge and professional development in psychiatry.</p><p><strong>Methods: </strong>This survey-based study at NUMC involved 16 attending psychiatrists and 13 past medical student mentees. Data were collected via electronic surveys from March to May 2022, examining effectiveness of mentorship and mentees' experiences. Descriptive analyses were performed using R (v. 4.1.2).</p><p><strong>Results: </strong>The attendings were mostly in the 46 to 55 years age group (37.5%), and a gender distribution showing a slight majority of females (56.25%). Regarding the mentorship, 75% of attendings reported that mentoring was not time-consuming, and all of them found it beneficial. All mentees (100%) confirmed that the clerkship improved their understanding of psychiatric disorders and interviewing skills. A significant 69.2% of mentees believed the mentorship model should be an essential component of the Psychiatry Clerkship, and 92.3% did not find the management of psychiatric disorders overly challenging.</p><p><strong>Conclusion: </strong>NUMC's Psychiatry Clerkship employs a strong mentorship model that markedly enhances medical education and prepares mentees effectively for psychiatric practice. Emphasizing empathy and interdisciplinary understanding, this model shows positive outcomes. Future research should include larger and more diverse cohorts to further substantiate and refine these mentorship practices in medical education.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241304142"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"An Act of Complete Care\": Provider Perspectives on Linking Maternal Contraceptive Care With Well-Baby Visits in Community Health Centers.","authors":"Amanda Knepper, Alejandra Zocchi, Sadia Haider, Rachel Caskey","doi":"10.1177/21501319241277421","DOIUrl":"10.1177/21501319241277421","url":null,"abstract":"<p><strong>Background: </strong>Short inter-pregnancy interval (IPI) is associated with adverse health outcomes for women and infants, and low-income women experience disproportionate rates of short IPI. An essential solution is providing postpartum (PP) women with timely contraceptive care. However, patient-centered approaches for facilitating care access are needed.</p><p><strong>Objective: </strong>To explore Community Health Center (CHC) staff and provider perspectives on the implementation of a clinical trial offering co-scheduled well-infant/maternal contraceptive care for women with infants 0 to 6 months at the Well-Baby Visit (WBV).</p><p><strong>Method: </strong>Eighteen participants (providers, staff, and administrators) representing 7 diverse CHC sites in 2 U.S. states completed semi-structured telephone interviews. Audio-recordings were transcribed and analyzed using hybrid thematic analysis.</p><p><strong>Results: </strong>Offering co-scheduled visits was perceived as beneficial for facilitating timely PP contraception, convenient care access, and encouraging family planning considerations during the PP period. However, provider and staff discomfort with initiating family planning and contraceptive care conversations at the WBV emerged as a salient barrier.</p><p><strong>Conclusion: </strong>Paired approaches to well-infant/maternal contraceptive care may promote increased access to timely contraception for PP women, possibly reducing unintended short IPI. Comprehensive training, ongoing support, and patient-centered implementation strategies tailored to context and developed with care team input are needed to ensure competency and comfortability with facilitating contraceptive care conversations at the WBV.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241277421"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11382232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Percentage of Patients Experiencing Financial Strain Depends on the Screening Measure: Evidence From a Cross-Sectional Survey of Adult Members of an Integrated Healthcare Delivery System.","authors":"Emma L Tucher, Richard W Grant, Nancy P Gordon","doi":"10.1177/21501319241277408","DOIUrl":"10.1177/21501319241277408","url":null,"abstract":"<p><strong>Objectives: </strong>Financial strain has important consequences for patients, providers, and health care systems. However, there is currently no gold standard measure to screen for financial strain. This study compared the performance of 3 single-item screeners using a composite measure of financial strain as a \"gold standard.\"</p><p><strong>Methods: </strong>We conducted a secondary analysis of unweighted data from a 2021 survey of Kaiser Permanente Northern California health plan members comparing the percentages of adults who experienced financial strain based on 3 general single-item screeners, a screener specific to medical and dental health care use, and a composite financial strain measure. The study sample was comprised of 2734 non-Medicaid insured adults who answered all financial strain questions. Kappa statistics evaluating agreement of the 3 general screeners with the composite measure were calculated for the sample overall, by age group, and within age group, by 4 levels of income and 4 racial/ethnic subgroups.</p><p><strong>Results: </strong>Among 947 adults aged 35 to 65, 30.7% had just enough money or not enough money to make ends meet, 23.3% had a somewhat hard or hard time paying for basics, 18.8% had trouble paying for ≥1 type of expense, 20.5% had delayed/used less medical/dental care, and 41.5% had experienced financial strain based on the composite measure. Among 1787 adults aged 66 to 85, the percentages who screened positive on these measures were 22.7%, 19.4%, 12.9%, 19.8%, and 34.4%, respectively. Across the sample, by income categories and racial/ethnic groups, the making ends meet screener identified higher percentages of adults experiencing financial strain and performed better when compared with the composite measure than the hard to pay for the very basics and trouble paying for expenses screeners. Overall, substantial decreases in the percentages of adults who screened positive on the financial strain measures were seen as level of income increased. Within income categories, middle-aged adults were more likely than older adults to have experienced financial strain based on the composite and general single-item screeners.</p><p><strong>Conclusions: </strong>As social risk screening becomes part of the standard of care, it will be important to assess how well different brief screeners for financial strain perform with diverse patient populations.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241277408"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11382230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Disruption Impact on Healthcare Delivery.","authors":"Maymunah Fatani, Abdulrahim Shamayleh, Hussam Alshraideh","doi":"10.1177/21501319241260351","DOIUrl":"10.1177/21501319241260351","url":null,"abstract":"<p><p>Health emergency outbreaks such as the COVID-19 pandemic make it challenging for healthcare systems to ration medical resources and patient care. Such disastrous events have been increasing over the past years and are becoming inevitable, necessitating the need for healthcare to be well-prepared and resilient to unpredictable rises in demand. Quantitative and qualitative based decision support systems increase the effectiveness of planning, alleviating uncertainties associated with the crisis. This study aims to understand how the COVID-19 pandemic has affected the performance of healthcare systems in different areas and to address the associated disruption. A cross-sectional online survey was conducted in the Kingdom of Saudi Arabia and the United Arab Emirates among healthcare workers who worked during the pandemic. The pandemic-related disruption and its psychometric properties were assessed using Structural Equations Modeling (SEM) with 5 latent factors: Staff Mental Health, Communication Level, Planning and Readiness, Healthcare Supply Chain, and Telehealth. Responses from highly qualified participants with many years of experience in hospital settings were collected and analyzed. Results show that the model satisfactorily fits the data with a CLI of 0.91 and TLI of 0.88. The model indicates that enhancing supply chain management, planning, telehealth usage, and communication level across the healthcare system can mitigate the disruption. However, the lack of mental health management for healthcare workers can significantly disrupt the quality of delivered care. Staff mental health and healthcare supply chain, respectively, are the highest contributors to varying degrees of disruption in healthcare delivery. This study provides a direction for more research focusing on determinants of healthcare efficiency. It also provides decision-makers insights into the main factors leading to disruptions in healthcare systems, allowing them to shape their outbreak response and better prepare for future health emergencies.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241260351"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11193933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Time Spent With Professional Medical Interpreters and the Care Experiences of Patients With Limited English Proficiency.","authors":"Pamela Torresdey, Jacob Chen, Hector P Rodriguez","doi":"10.1177/21501319241264168","DOIUrl":"10.1177/21501319241264168","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>More time spent with interpreters may support clinician-patient communication for patients with limited English proficiency (LEP), especially when interpreter support before and after clinical encounters is considered. We assessed whether more time spent with interpreters is associated with better patient-reported experiences of clinician-patient communication and interpreter support among patients with LEP.</p><p><strong>Methods: </strong>Patients with LEP (n = 338) were surveyed about their experiences with both the clinician and interpreter. Duration of interpreter support during the encounter (in min) and auxiliary time spent before and after encounters supporting patients (in min) were documented by interpreters. Multivariable linear regression models were estimated to assess the association of the time duration of interpreter support and patient experiences of (1) clinician-patient communication, and (2) interpreter support, controlling for patient and encounter characteristics.</p><p><strong>Results: </strong>The average encounter duration was 47.7 min (standard deviation, SD = 25.1), the average auxiliary time was 43.8 min (SD = 16.4), and the average total interpreter time was 91.1 min (SD = 28.6). LEP patients reported better experiences of interpreter support with a mean score of 97.4 out of 100 (SD = 6.99) compared to clinician-patient communication, with a mean score of 93.7 out of 100 (SD = 14.1). In adjusted analyses, total patient time spent with an interpreter was associated with better patient experiences of clinician-patient communication (β = 7.23, <i>P</i> < .01) when auxiliary time spent by interpreters supporting patients before and after the encounter was considered, but not when only the encounter time was considered.</p><p><strong>Conclusions: </strong>Longer duration of time spent with an interpreter was associated with better clinician-patient communication for patients with LEP when time spent with an interpreter before and after the clinician encounter is considered. Policymakers should consider reimbursing health care organizations for time interpreters spend providing patient navigation and other support beyond clinical encounters.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241264168"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11265237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health Outcomes for Young People Accessing Individual Placement Support Services: A Cohort Study.","authors":"Nic Telford, Sabina Albrecht, Alice Wilkin, Carolyn Watts, Debra Rickwood","doi":"10.1177/21501319241296786","DOIUrl":"10.1177/21501319241296786","url":null,"abstract":"<p><strong>Objective: </strong>Mental health problems and vocational disengagement are often linked for young people in a self-reinforcing cycle. Integrated Individual Placement and Support (IPS) services can help to not only overcome educational/vocational challenges but also improve mental wellbeing.</p><p><strong>Methods: </strong>In a matched cohort study, we compared improvement rates in mental health and wellbeing outcomes for young people aged 15 to 25 who had received at least two integrated IPS services with those who had received standard youth mental health services only. Data came from headspace, Australia's National Youth Mental Health Foundation. The sample comprised 2128 participants: 544 received integrated IPS services; 1584 received standard mental health services.</p><p><strong>Results: </strong>Four out of five IPS clients (81%) achieved positive outcomes on at least one of three mental health measures, a significantly higher proportion than matched clients who received standard services (75%). Logistic regressions estimated a 22% to 36% higher likelihood of achieving significant improvement for IPS clients. Greater improvements were evident for quality of life and potentially psychosocial functioning, but not psychological distress.</p><p><strong>Conclusions: </strong>Integrating an IPS program within a clinical setting not only achieves positive vocational outcomes, but also supports improvements in quality of life, psychosocial functioning and psychological distress that are greater or equal to the outcomes achieved through standard clinical care.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241296786"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Escalating Violence and Associated Fear of Crime Worsen Psychological Well-Being in Community Dwellers Living in a Rural Setting? Results From the Atahualpa Project Cohort.","authors":"Oscar H Del Brutto, Robertino M Mera, Denisse A Rumbea, Emilio E Arias, Mark J Sedler","doi":"10.1177/21501319241273167","DOIUrl":"10.1177/21501319241273167","url":null,"abstract":"<p><strong>Background: </strong>Escalating street violence and criminal homicides have an adverse impact on psychological well-being. However, these consequences have been difficult to evaluate. Using a recently validated scale, we aimed to assess the impact of fear of crime on the psychological status of middle-aged and older adults living in a rural setting afflicted by endemic violence.</p><p><strong>Methods: </strong>Participants were selected from Atahualpa residents included in previous studies targeting psychological distress in the population. A validated scale was used to objectively quantify fear of crime in participants. Differences in symptoms of depression and anxiety between baseline and follow-up were used as distinct dependent variables and the continuous score of the fear of crime scale was used as the independent variable. Linear regression models were fitted to assess the association between the exposure and the outcomes, after adjusting for relevant confounders.</p><p><strong>Results: </strong>A total of 653 participants (mean age = 53.2 ± 11.5 years; 57% women) completed the requested tests. We found a 13% increase in symptoms of depression and anxiety during the peak of violence in the village compared with previous years. Linear regression models showed a significant association between the total score on the fear of crime questionnaire and worsening symptoms of depression (β = .24; 95% CI = 0.14-0.35) and anxiety (β = .31; 95% CI = 0.24-0.37), after adjustment for relevant confounders.</p><p><strong>Conclusions: </strong>This study shows a significant aggravating effect of fear of crime on pre-existing symptoms of depression and anxiety and a deleterious effect of these conditions on overall well-being.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241273167"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11327983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical Considerations and Implementation of Sodium-Glucose Co-Transporter-2 Inhibitors in Chronic Kidney Disease: Who, When, and How? A Position Statement by Nephrologists.","authors":"Anjay Rastogi, Ashté Collins, Ellie Kelepouris, Wayne Kotzker, John P Middleton, Minesh Rajpal, Prabir Roy-Chaudhury, Glenn M Chertow","doi":"10.1177/21501319241259905","DOIUrl":"10.1177/21501319241259905","url":null,"abstract":"<p><strong>Introduction: </strong>There remains an unmet need to reduce kidney and cardiovascular risk in patients with chronic kidney disease (CKD). This report is therefore intended to provide real-world clinical guidance to primary care providers on sodium-glucose co-transporter-2 (SGLT2) inhibitor use in patients with CKD, focusing on practical considerations. Initially developed as glucose-lowering drugs, SGLT2 inhibitors preserve kidney function and reduce risks of cardiovascular events and mortality. Clinical benefits of SGLT2 inhibitors in CKD have been demonstrated in multiple clinical trials, yet utilization in practice remains relatively low, likely due to the complexity of labeled indications (past and present) and misconceptions about SGLT2 inhibitors as a class.</p><p><strong>Methods: </strong>A panel of 8 US-based nephrologists convened in August 2022 to develop consensus guidance for the primary care community surrounding risk assessment as well as initiation and implementation of SGLT2 inhibitors in patients with CKD. Here, we provide an adapted version of the Kidney Disease: Improving Global Outcomes (KDIGO) heatmap and a treatment-decision algorithm.</p><p><strong>Conclusions: </strong>We advocate SGLT2 inhibitors as co-first-line therapy with renin-angiotensin-aldosterone system (RAAS) inhibitors, where RAAS inhibitor dose titration need not be completed before initiation of an SGLT2 inhibitor. In fact, SGLT2 inhibitor therapy may facilitate up-titration or maintenance of optimal RAAS inhibitor dosing. We describe potential strategies to aid implementation of an SGLT2 inhibitor in clinical practice, including improving education and awareness among care providers and patients and dispelling misconceptions about the safety of SGLT2 inhibitors. In summary, we support the use of SGLT2 inhibitors with RAAS inhibitors as co-first-line therapy in most patients with CKD.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241259905"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11327967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}